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腹腔镜肝切除术治疗肝内胆管细胞癌:单中心经验。

Laparoscopic Liver Resection for Intrahepatic Cholangiocarcinoma: A Single-Center Experience.

机构信息

Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Berlin School of Integrative Oncology (BSIO), Berlin, Germany.

出版信息

J Laparoendosc Adv Surg Tech A. 2020 Dec;30(12):1354-1359. doi: 10.1089/lap.2020.0215. Epub 2020 Jun 5.

Abstract

Despite recent advances in the field of laparoscopic liver surgery, intrahepatic cholangiocarcinoma (iCC) as an entity has been nearly exempted from the new approaches because of proposed technical difficulties in achieving lymphadenectomy (LAD) and beneficial oncologic outcomes. Clinical courses of all consecutive patients ( = 159) undergoing liver resection for iCC at the Department of Surgery, Charité-Universitätsmedizin between January 2015 and October 2019 were studied. Ultimately, after applying selection criteria 27 laparoscopic liver resections were compared with 31 open liver resections. Preoperative patient characteristics were similar with regard to general health and tumor characteristics. However, patients in the laparoscopic group tended to have more advanced liver fibrosis. When LAD was performed laparoscopically, a median of eight lymph nodes were resected, complying with current AJCC treatment guidelines. Patients undergoing laparoscopic resection showed lower overall morbidity contributing at least in part to a markedly decreased hospital stay. Herein, we report on one of the largest series of laparoscopically resected iCC, with a high proportion of major resections. Our data show laparoscopic resection to achieve noninferior outcomes to open resection despite impaired preoperative liver function.

摘要

尽管腹腔镜肝外科领域取得了最近的进展,但由于在实现淋巴结清扫术(LAD)和获得有益的肿瘤学结果方面存在技术困难,肝内胆管癌(iCC)作为一种实体几乎被排除在新方法之外。 对 2015 年 1 月至 2019 年 10 月期间在 Charité-Universitätsmedizin 外科部门接受 iCC 肝切除术的所有连续患者( = 159)的临床过程进行了研究。最终,在应用选择标准后,将 27 例腹腔镜肝切除术与 31 例开腹肝切除术进行了比较。 术前患者特征在一般健康和肿瘤特征方面相似。然而,腹腔镜组的患者倾向于具有更严重的肝纤维化。当腹腔镜进行 LAD 时,切除了中位数为 8 个淋巴结,符合当前 AJCC 治疗指南。接受腹腔镜切除的患者总体发病率较低,这至少部分归因于住院时间明显缩短。 在此,我们报告了腹腔镜切除 iCC 的最大系列之一,其中大部分为主要切除术。我们的数据表明,尽管术前肝功能受损,腹腔镜切除仍能达到与开腹切除相当的效果。

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